By filling in the following form you are hereby agreeing to all membership responsibilities and requirements.
Members are PAP's most important resource! Membership is voluntary and open to all individuals, organizations, foundations, and businesses who wish to collaborate with PAP in its goal, mission and activities. (There is no membership fee.) Members are encouraged to attend and participate in full partnership meetings and activities as scheduled. Members become eligible for election to the Executive Committee which provides leadership to PAP. Members need not be in total agreement on all issues, however, members will be expected to be respectful of differing voices and opinions while sharing their voice in crafting the shared vision and activities of PAP.
Fill out the fields below and click next to continue with the remainder of the application.
Salutation Dr. Mr. Ms. Mrs.
First Name *
Middle Initial
Last Name *
Address *
Apt/Suite/PO Box
City *
State *
Zip Code *
Phone Number
Email Address *
Confirm Email Address *
Organization/Agency *
Department
Job Title *
Please fill out your background information to continue with the application.
High school Associates degree Bachelors Masters Doctorate *
RRT RN MD/DO AE-C Other
Other
Community Outreach Organization Consumer/Personal Connection County/Municipal Agency Environmental Federal Agency Insurer Local Coalition Medicaid Medical Center Non-profit Pharmaceutical Physician Public Health Registered Nurse Respiratory Therapist State Agency Other *
The Partnership has developed workgroups whose purpose reflects our mission and both short and long term project goals. Please select one or more of the following workgroups that you would like to be actively involved with. Workgroups typically meet monthly or every other month.
Asthma Outreach and Education: Working to eliminate environmental impacts on asthma, and to optimize individuals' self-management of asthma through education in schools, homes, and workplaces.
Provider: Increasing healthcare provider use of evidence-based, national asthma treatment guidelines.
Public Policy: Changing public policy to improve asthma care.
Asthma Outreach and Education Provider Public Policy
The Partnership's most important resource is our members. All members are asked to provide any resources or information possible to help further the common overall missions, goals, and statewide asthma action plan. Please select all ways that you could contribute to the Partnership.
Professional expertise Volunteer time Financial resources Public speaking Ability to teach/train people Ability to teach/train health care professionals Community outreach Marketing/Communications assistance Database development Website development Access to others such as those listed below Other
Schools Faith-based organizations Community-based organizations Corporations Individuals with asthma Professional organizations Other
Thank you for completing PAP's online application form! You will receive an email confirming receipt of your application shortly. Thank you for your interest in the PA Asthma Partnership!
